Diagnosis, treating and preventing human illness is one of the most information-intensive of all intellectual activities. However, less than 5% of U.S. physicians are currently using computers for clinical purposes. Providers often do not have or cannot find the information they need to respond quickly and appropriately to patient medical problems. Information of value is not widely shared, and paper output of existing systems must be manually collated in what is called a Patient Medical Record (PMR) or "chart." That portion of the PMR which contains clinical data is referred to as the Clinical Patient Record (CPR). The paper-based patient medical record can be in only one place at a time.
Health care providers, payers, information system vendors, and state governments have teamed to plan and build Health Information Networks (HINs) in at least 11 states. Simultaneously, a host of large corporations have constructed proprietary HINs for processing clinical Electronic Data Interchange (EDI) transactions, including both data and images such as x-rays. These attempts to provide informational interchange have involved all sectors of the industry. Also, the proliferation of the global network commonly referred to as the "Internet" has been used to exchange information between different entities in the health care community. Thus far, these system have been primarily limited to very specialized health care applications. For example, U.S. Pat. No. 5,715,823 discloses a medical ultrasonic diagnostic imaging system capable of being accessed over the Internet, making ultrasonic images, diagnostic reports, and ultrasound diagnostics information and operation accessible to a conventional PC.
While other databases created by health care service providers and medical equipment suppliers are available, access is usually limited. Typically, many systems require the payment of a fee or participation in a restricted organization in order to gain authority to utilize the database. Many others available on the Internet are limited in terms of features and services provided. The strong forces of market-oriented health care reform, the accelerating growth of managed care plans and capitated payment necessitate the automation and re-engineering of the labor intensive, paper-based processes associated with the medical profession.
One barrier to implementation of these networks has been resistance by practicing physicians. Many physicians are computer-phobic and resistant to change in their practice methods. There is an industry-wide consensus that physicians will routinely use hospital and office computers only when they become easy to use and when they provide significant applications that save time, improve productivity, and streamline the patient care process.
Another barrier to effective operation of such community health networks has been an inability to electronically transfer patient test records between a variety of geographically dispersed offices and display them in an effective standardized format. Many smaller clinical laboratories still mail office test results to doctors. The larger labs deliver results of individual tests by courier, fax, or using an on-site printer. Relying on paper, fax and phones for reporting this information significantly reduces productivity and increases costs throughout the health care field. No U.S. hospital or freestanding clinical lab yet reports results of the billions of biochemical and microbiology tests to doctors in a standardized and integrated format.
U.S. Pat. No. 4,315,309 to Robert Coli, M.D. discloses an integrated medical test data storage and retrieval system for use in a single facility such as a hospital, as shown in FIG. 1. Test request 2 is generated by a physician or other medical personnel and entered into the system through test request entry terminals 4 placed throughout the hospital. The test request is forwarded to test request compiler 6 for storage in a test request file 8, which periodically generates specimen pickup lists 10 which are distributed to wards in the hospital. Body fluids or tissue samples are forwarded to laboratory 12 in individual specimen containers 14. The tests are performed in laboratory 12 in accordance with a work profile generated on profile sheets 16. The results are recorded and entered at entry terminal 18, and forwarded to patient result compiler 20 for storage in a patient result file 22. Compiler 20 generates a ward report 24 listing tests in progress for that ward, and a diagnostic data system patient lab report 26 which is formatted to provide cumulative results reporting. With this reporting format, the test results are presented by assigning a vertical column of the page or display screen to each test, and a horizontal row to each date and time that tests were performed. In this manner, the information for each patient is presented concisely and in a manner that facilitates effective problem diagnosis.
However, as can be seen, this early system was designed to operate within a single large hospital facility, and does not provide any ability to place test orders or receive test data over a network. For example, the disclosed system does not connect a doctor's office to an outpatient laboratory or clinic where patients may be sent for lab work, and does not facilitate selection of a particular laboratory from those that may be capable of performing a specific test.
Other clinical data processing systems are provided in U.S. Pat. Nos. 3,872,448 to Mitchell, Jr., 5,099,424 to Schneiderman, 5,262,943 to Thibado et al., 5,551,022 to Tariq et al., 5,265,010 to Evans-Paganelli et al., 5,262,944 to Weisner et al., 5,072,383 to Brimm et al., 5,392,209 to Eason et al., 5,327,341 to Whalen et al., 5,549,117 to Tacklind et al., 5,277,188 to Selker, and 5546,580 to Seliger et al. However, arrangements of the types disclosed in these references similarly fail to provide medical practitioners with an optimal networked test ordering and results reporting system.
Thus, there is a need for an improved networked computer system that provides integrated electronic test selection and results reporting, with the tests organized in a consistent and easy-to-understand manner for both selection of the tests to be performed, and reporting of the results. There is also a need for a system that provides effective communication of test orders and results between a physician's office and a remote laboratory. Moreover, there is a need for a system of this type that will identify for the physician the local laboratories capable of performing a specific test, and permit selection among those laboratories and appropriate transmission of the test order, preferably over the Internet.